- CareFirst (Baltimore, MD)
- …across Medicare & Medicaid populations. Responsible for developing performance monitoring reports and analytics related to Risk Adjustment & Stars programs ... **Resp & Qualifications** **PURPOSE:** Supports Risk Adjustment & Stars organization to...indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of… more
- Providence (NM)
- …Medicare Advantage plans + Have a deep understanding of Medicare Advantage regulations, risk adjustment methodologies, and a strong analytical background + Be ... the pricing process + Staying informed of changes in risk adjustment methodologies and assess their implications...study + Successful completion of 4+ exams of the Associate of the Society of Actuaries (ASA) designation +… more
- Johns Hopkins University (Baltimore, MD)
- …The JH-ACG's research and development team is an international leader in health care risk adjustment and advanced predictive analytics . JH-ACG solution is an ... fields of population health, health care delivery systems, health policy, and risk stratification/prediction. A special emphasis of this position is on the… more
- RELX INC (Boca Raton, FL)
- About the Business LexisNexis Risk Solutions is the essential partner in the assessment of risk . Within our Business Services vertical, we offer a multitude of ... Laundering/Counter Terrorist Financing, Identity Authentication & Verification, Fraud and Credit Risk mitigation and Customer Data Management. You can learn more… more
- Commonwealth Care Alliance (Boston, MA)
- …+ Maintain current industry knowledge of highly impactful external audits such as Risk Adjustment Data Validation Audit, CMS Program Audit protocols, common ... + Contribute towards the maintenance and enhancement of an effective Compliance Risk Assessment Program + Project manage regulator and other external reviews as… more
- Highmark Health (Columbus, OH)
- …Centers for Medicare and Medicaid Services (CMS) coding guidelines, and support of Risk Adjustment Data Validation (RADV) audits. Works closely with colleagues, ... quality and compliance), and/or physicians to identify and deliver high quality and accurate risk adjustment coding. Supports all risk adjustment … more
- RELX INC (Boca Raton, FL)
- …advanced technology and analytics to assist them in evaluating and predicting risk and enhancing operational efficiency. We use the power of data and advanced ... provide solutions that use vast data sets and advanced analytics to evaluate and predict risk . Use...2-4 years of related experience + High school diploma: Associate degree preferred + In-depth knowledge in Microsoft Office… more
- RELX INC (Alpharetta, GA)
- …technology and analytics to assist them in evaluating and predicting risk and enhancing operational efficiency. Our insurance risk solutions help drive ... sales as a professional career? About the Business LexisNexis Risk Solutions is the essential partner in the assessment... Solutions is a leading provider of data and analytics to the insurance industry. We aim to assist… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …and utilization metrics across medical/pharmacy service categories, benchmarking methodologies, retention/leakage analytics , and Medicare risk adjustment + ... including population health management, quality measurement and performance improvement, risk adjustment and coding, and product management...and that work/life balance is a key part of associate wellbeing. For more information on how we work… more
- Walmart (Bentonville, AR)
- …for the development and delivery of provider education and training as assigned, including risk adjustment , quality, focus on care, and optimal care. + Develops ... Prior working experience in educational training content, Sharepoint, or LMS systems., Risk adjustment or quality. **Primary Location ** 2608 Se J… more
- Providence (NM)
- …the rate development and filing efforts including competitive analysis, network analysis, risk adjustment , trend, actuarial benefit value analysis, rate adequacy ... another related field of study + Successful completion of 4+ exams of the Associate of the Society of Actuaries (ASA) designation + 5+ years of healthcare actuarial… more
- Humana (Columbus, OH)
- …market-based processes that support Provider Engagement, Quality/Stars, Interoperability, and Medicare Risk Adjustment (MRA) business levers. This role calls for ... existing operating model by leveraging performance and productivity data and front-line associate feedback + Optimize the operating model by identifying and scaling… more
- Walmart (Potsdam, NY)
- …training (for example, safety, control troubleshooting, oil system operation and adjustment ) by traveling to company facilities for on-site sessions; performing ... Demonstrates curiosity and a growth mindset; supports innovation and intelligent risk -taking; and exhibits resilience in the face of setbacks. Digital Transformation… more
- Walmart (Middletown, KY)
- …training (for example, safety, control troubleshooting, oil system operation and adjustment ) by traveling to company facilities for on-site sessions; performing ... Demonstrates curiosity and a growth mindset; supports innovation and intelligent risk -taking; and exhibits resilience in the face of setbacks. Digital Transformation… more
- UT Health San Antonio (San Antonio, TX)
- …as requested by department. 5. Analyze and present initial denial and adjustment revenue cycle measures during monthly Revenue Cycle Meetings. 6. Use available ... Approve and execute write-off requests over $500. 11. Assists in managing high risk work queues via practice management system. 12. Assists in managing employee… more